Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 303 M Termination Date Change due to Beneficiary Merge TRM DT CHG MERGE This TRC is returned on a reply with Transaction Type 01. It is not a reply to a submitted transaction but is intended to supply the Plan with additional information about the beneficiary. This beneficiary had multiple conflicting claim numbers (HICNs) which were merged into one. Plan enrollments for the conflicting HICNs have been combined under a valid HICN. This enrollment conflicted with another existing enrollment. Current enrollment rules regarding the application signature date were applied and this enrollment’s termination date was changed from the original date. The effective date of the enrollment with the changed termination date is reported in the Effective Date field (18). The new termination date of this enrollment is reported in Field 24. 305 M ZIP Code Change 306 R NUNCMO Change Rejected, No Part D Eligibility 307 A MMP Passive Enrollment Accepted ZIP CODE CHANGE NUNCMO, NO PTD PASSIVE ACCEPT Plan Action: Because the termination date has changed, the enrollment period should be adjusted in the Plan’s enrollment records. This change may impact premiums that you collected directly from the beneficiary. Take the appropriate actions as per CMS enrollment guidance. A notification has been received that this beneficiary’s zip code has changed. The new zip code is reported in field 24 of the TRR. The effective date of the change is reported in field 18. Note: A reply with this TRC only reports changes in the Zip Code the beneficiary has on file with SSA/CMS. It does not report changes in a Plan-submitted Residence Address. Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Take the appropriate actions as per CMS enrollment guidance. A NUNCMO Change transaction (Transaction Type 73) was rejected because beneficiary does not have Part D Eligibility as of the submitted effective date. Plan Action: Verify the beneficiary identifying information and resubmit the transaction with updated information, if appropriate. An MMP passive enrollment transaction (TC 61) successfully processed. The effective date of the new enrollment is reported in DTRR field 18. This is the definitive enrollment acceptance record. Other accompanying replies with different TRCs may give additional information about this enrollment. Plan Action: Ensure the Plan’s system matches the information included in the DTRR record. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-69 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 308 R MMP Passive Enrollment Rejected 309 I No Change in MMP Opt- Out Flag 310 R MMP Opt- Out Rejected, Invalid Opt- Out Code 311 A MMP Opt- Out Accepted 312 A MMP Enrollment Cancellation Accepted 313 R MMP Enrollment Cancellation Rejected PASSIVE REJECT DUP FA OPT OUT BAD FA OPT OUT FA OPT OUT ACPT ACPT FA CANCEL RJCT FA CANCEL An MMP passive enrollment transaction (TC 61) was rejected because the beneficiary did not meet the MMP requirements or the beneficiary opted out of passive enrollment. The attempted enrollment effective date is reported in DTRR fields 18 and 24. Plan Action: Take the appropriate actions as per CMS enrollment guidance. An MMP Opt-Out Record Update transaction (TCs 42, 83) was submitted; however, no data change was made to the beneficiary’s record. The submitted transaction contained an MMP Opt-Out Flag value that matched the MMP Opt-Out already on record with CMS. This transaction did not affect the beneficiary’s records. Plan Action: None required. An opt-out from CMS, disenrollment, or Plan submitted Opt-Out transaction (TCs 42, 51, 54, 82, 83) was rejected because the MMP Opt-Out Flag field was incorrectly populated. The valid values for MMP Opt-Out are: TCs 42 or 83 transactions - ‘Y’ or ‘N’ All other TCs - ‘Y,’ ‘N,’ or blank Plan Action: If submitted by the Plan (TCs 51, 82, 83), correct the MMP Opt-Out Flag value and resubmit the transaction if appropriate. A transaction (TCs 42, 51, 54, 82, 83) was received that specified an MMP Opt-Out Flag value or a change to the MMP Opt-Out Flag value. The MMP Opt-Out Flag was accepted. The new MMP Opt-Out Flag value is reported in DTRR field 70. Plan Action: No action necessary. An Enrollment Cancellation (TC 82) was accepted. The identified enrollment was cancelled. The start date of the cancelled enrollment period is reported in DTRR field 18. Plan Action: Update the Plan’s records accordingly. An MMP Enrollment Cancellation (TC 82) transaction was rejected because the cancellation was submitted after the enrollment became active. Plan Action: Submit a Disenrollment transaction. December 28, 2012 I-70 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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